Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University <p>The Annals of Pakistan Institute of Medical Sciences (APIMS) is the Official quarterly and open access journal of Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Pakistan. Previously two separate medical journals of this institute were being published, namely, JPIMS started from 1990 and the Journal of Surgery 1991. They were officially merged into one journal APIMS in 2005. Annals of PIMS is recognized by Pakistan Medical and Dental Council (PMDC), Higher Education Commission of Pakistan ( Y category), CPSP <a href="" target="_blank" rel="noopener">(</a> index in EBSCO Host &amp; Base from Germany. </p> en-US <p><a href="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons License" /></a><br />This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p> (Editorial Board) (SZABMU) Sun, 11 Sep 2022 16:56:18 +0300 OJS 60 Case Report: Ulcerated Adenomyoma presenting as CA Endometrium <p>During this COVID pandemic cancer surgeries are still being carried out via necessary precautions.Endomertial carcinoma is one of the easiest carcinoma to pick and early surgical treatment can completely cure it. Adenomyosis on the other hand is the presence of ectopic <a href="">endometrial tissue</a>&nbsp; with in myometrium if it involves the uterus focally it is known as adenomyoma. Radiological findings of adenomyoma can be mistaken for endometrial carcinoma. We present such a case in which radiologically diagnosed endometrial carcinoma turned out to be adenomyoma on histopathology.</p> Zeenat Usman, Majida Zafar, Syeda Batool Mazhar Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Thu, 15 Sep 2022 00:00:00 +0300 Relationship of Diabetes Mellitus Among The Patients Reporting With Facial Space Infection <p>Objective: To determine the frequency of diabetic patients having Odontogenic Maxillofacial space infections in local population.</p> <p>Methodology: This cross sectional study was carried out from 1-3-2020 to August 2020 in the Department of Oral and Maxillofacial Surgery, Pakistan Institute of Medical Sciences, Islamabad, to assess the frequency and association of diabetics with facial space infection. A total of 70 patients of both genders with Odontogenic maxillofacial infection were included in the study. Patients were stratified into three age groups; Age group 1 was from 18-30, Age group 2 from 31-45 years and Age group 3 from 46-60 years. This form includes demographic data (age, gender, contact information, address), medical history (diabetic or non-diabetic) along with sign and symptoms were noted in the Performa. The SPSS version 20.0 was used to analyze the data. Mean and standard deviation was calculated for age. Frequency and percentages were used for the gender and diabetes mellitus.</p> <p>Results: A total of 70 patients having Odontogenic maxillofacial space infection. Of these 70 study cases, 42 (60%) were females and 28 (40%) were males with mean age of 40.97±10.32 years. Out of 70 patients, 55 (78.57%) were diabetic and 15 (21.43%) patients were non-diabetic patients.</p> <p>Conclusion: Diabetic patients are more prone to Odontogenic maxillofacial space infections and due to poor diabetic control multispace infection along with severe complications may occur.</p> Mor khan Shar, Sana Ali, Muhammad Umar , Hanum Sadiq, Muhammad Junaid , Zahoor Ahmed Rana Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Diagnostic Accuracy and Imaging Appearance Glioblastoma Multiforme on MRI and MRS <p><strong>Objective: </strong>To determine the diagnostic accuracy of contrast-enhanced MRI with conventional sequences and MR Spectroscopy in the diagnosis of Glioblastoma Multiforme, taking histopathology as the gold standard. We also determined the MR imaging appearance of GBM on conventional sequences.</p> <p><strong>Methodology: </strong>This descriptive cross-sectional study was conducted at a tertiary care hospital from 19<sup>th</sup> August 2019 to 18<sup>th</sup> August 2020 on 165 adult patients suspected of having an intracranial space-occupying lesion. Informed consent was sought and a questionnaire was filled out for patient data, MRI imaging findings, and MRS results.</p> <p>Histopathology results were subsequently followed and recorded. The diagnostic accuracy of contrast enhanced MRI brain as well as MRS was determined in terms of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy, taking histopathology as gold standard.</p> <p><strong>Results: </strong>In a total of 165 patients selected for the study, the mean age was 56.34±10.04 years with a male to female ratio of 1:1 and the frontal lobe being the most common location (34.5%). In histopathological positive GBM cases, margins of the mass were ill-defined in 55.1%, intralesional low ADC values were observed in 63.3%, signal drop out on susceptibility imaging in 42.8%, and MRS with raised choline and reduced NAA in 75.5%. MRI had a sensitivity of 81.6% and&nbsp; specificity of 94.8%, and MRS has a sensitivity of 75.5% and a specificity of 100%.</p> <p><strong>Conclusion: </strong>Ill-defined margins, necrosis, and hemorrhage are important MRI features suggesting GBM. MRS combined with conventional MR sequences has high sensitivity and specificity in its diagnosis.</p> Nasreen Naz, Arti Chandani, Areej Fatima, Nida Rafique, Javerya Sattar Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Modified Kenalog Protocol for Perianal Fissures- A Quasi Experimental Trial <h1>Objective: To ascertain the role of triamcinolone injection at the base of an anal fissure and its effect on healing and pain relief.</h1> <h1>Methodology: A quasi-experimental study was conducted from November 2021 to February 2022. Under aseptic measures, a 1ml Triamcinolone 40mg/ml injection was administered at the base of the anal fissure using a 1cc insulin syringe. This was injected in four positions around the base of the fissure. Patients were followed for one week to assess pain relief and improvement in quality of life. Patients were assessed for quality of life improvement and satisfaction with treatment. Patients were offered lateral internal sphincterotomy at the end of one week and again on follow up after two weeks given they were not satisfied with pain relief or symptom recurrence occurred.</h1> <h1>Results: Twenty five patients were enrolled and analysed. All fissures were seen to have a red inflamed base at enrollment. At one week after treatment, a paler base with less signs of inflammation was observed. Patients reported a mean 70% improvement in their symptoms. A mean change of 16.45 points was seen in Brief Pain Inventory scores at one-week follow up. 25% underwent a lateral internal sphincterotomy. The number needed to treat was 2.5. 5 patients were lost to follow-up after the initial one week follow-up.</h1> <h1>Conclusion: Injection of Triamcinolone at the base of an anal fissure may have a role as an adjunct to standard management in treatment. It has been shown to decrease pain and enhance healing of the fissure thus decreasing the need for surgical intervention.</h1> Vishal Farid Raza, Qaiser Mahmood, Iqra Waris, Muhammad Shahwaiz Malik, Khalid Javeed Khan Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Functional Echocardiography (FNECHO): Experience in NICU of A Tertiary Care Hospital <p>Objective: To describe the observational findings of functional echocardiography (FnEcho) in neonatal intensive care unit of a tertiary care hospital by evaluating its frequency of use, characteristics of patients and distribution of heart diseases.</p> <p>Methodology: This Prospective descriptive observational study was done in a tertiary neonatal intensive care unit (NICU) in Rawalpindi, from July 2017 to June 2018. A total of two hundred and twelve neonates admitted to the NICU undergoing echocardiographic assessment were included in the study. Qualitative variables like gender, mode of delivery, and diagnostic findings were represented in terms of frequency and percentages. Quantitative data like age, birth weight and gestational age were highlighted as mean and standard deviation.</p> <p>Results: Out of a total of 212 neonates, 111 (52.4%) were male. The mode of delivery was noted to be lower segment cesarean section among 126 (60.0%) neonates. The mean gestational age was found to be 36.47+2.3 weeks, ranging from 28 to 41 weeks, whereas the mean birth weight was 2.56+0.68 kg, ranging from 1.1 to 4.2 kg. A total of 75 neonates were found to have functional heart disease in the form of pulmonary hypertension 37 (17.4%), hemodynamically significant patent ductus arteriosus 24(11.3%), hypoxic ischemic cardiomyopathy 4(1.9%), and systemic hypotension 10 (17.4%).</p> <p>Conclusion: FnEcho was found to be an effective tool for identifying different kinds of functional and structural heart defects. VSD was found to be the most common type of congenital heart disease, followed by PDA. Timely intervention in PPHN was also rewarding with good outcome.</p> Fahim Ahmed Subhani, Awais ul Hassan, Ammara Ayub , Abdul Wahab Siddique , Asad Maqbool Ahmed, Asma Razzaq Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Comparison the Clinical Effect of 2% Chlorhexidine and MTAD as Final Rinse in Controlling Post Operative Pain in Single Visit Root Canal Treatment <p>Objectives: To compare the mean postoperative pain associated with the use of 2% chlorhexidine or MTAD as final rinse in cases of Symptomatic Apical Periodontitis presenting to the LUMHS operative dentistry department for single visit root canal treatment.</p> <p>Methodology: This single blind randomized controlled trial was conducted at the Department of Conservative Dentistry LUMHS, Jamshoro from February to June 2018. We included 60 patients' teeth with symptomatic apical periodontics. Thirty patients in group A received 2% chlorhexidine solution, while thirty patients in group B received MTAD. Preoperative and postoperative pain levels were assessed using a visual analogue scale.</p> <p>For qualitative variables such as gender, tooth type, and pre and postoperative pain, frequency and percentages were calculated. The chi-square test with a p value of 0.05 was used to compare the two groups.</p> <p>Results: The mean age in both groups were 30 years. Most of the teeth involved in both groups were on the anterior side. Patients in group A had an average age of 30.97±7.29 years. There was no statistically significant difference in the mean pain score between groups at p=0.86 after 7 days, with a score of 0.97 for group A and 0.93 for group B, respectively.</p> <p>Conclusion: Chlorhexidine and MTAD groups have been equally effective in reducing postoperative pain in a single visit as a final rinse.</p> Rajesh Kumar, Naresh Kumar, Hareem Qazi, Priya Rani Harjani, Sarang Suresh Hotchandani, Muhammad Muzamil Alvi Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Determinants of Anxiety in Amputees Owed to Traumatic & Non-Traumatic Causes in Quetta <p>Objective: To find out the causes and factors of anxiety among amputees suffering from traumatic and non-traumatic causes.</p> <p>Methodology: This descriptive cross-sectional study was conducted in Quetta from the month of May 2018 to July 2018. This study included those clients with amputations as a result of Traumatic &amp; non-traumatic causes and the data was collected from them. This study involved a total of 54 participants. All amputees who visited the three Physical Rehabilitation Centre were included during data collection process. A structured adopted questionnaire using the Hospital Anxiety and Depression Scale (HADS) according to the inclusion &amp; exclusion criteria &amp; then tabularized and analyzed by applying Chi square test.</p> <p>Results: This study involved a total of 54 participants of whom 7(13%) were females and 47(87%) males. Among amputees 36(66.7 %), amputations were due to Traumatic injuries and 18(33.3%) were due to non-traumatic amputations. In traumatic, the majority was due to RTA with 25(46.3 %) and in non-traumatic causes diabetes stood first with 13(24.1%) amputation. Traumatic are more anxious than non-traumatic. There is a significant relationship between marital status and anxiety level (p-value 0.047). Statistically significant relationships between amputation and anxiety level were noticed, p value=0.049.</p> <p>Conclusion: Amputation has a significant association with anxiety level. Traumatic experiences make people feel more anxious than non-traumatic ones. Socio-demographics has association with levels of anxiety. It is recommended to do regular or annual screening of these patients following amputation.</p> Abdul Baqi, Shahid Pervez Shaikh, Muhammad Shoaib Zia, Muhammad Mohsin Javaid, M. Shaharyar Malik, Qasim Zia Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 BCR-ABL1 Gene Mutation in Acute Lymphoblastic Leukemia <p>Objective: Determination of frequency of BCR-ABL1 gene mutation in Acute Lymphoblastic Leukemia.</p> <p>Methodology: This cross sectional study was carried out at the Department of Molecular Haematology, Armed Forces Institute of Pathology between January 2018 to March 2021. All newly diagnosed patients of Acute Lymphoblastic Leukemia were included in the study while patients already on treatment and with secondary leukemia were excluded from the study. Blood counts were done and various parameters such as total leukocyte count, hemoglobin, and platelet count were calculated.</p> <p>Results: 623 patients were included in the study. BCR-ABL gene was positive in 105 (16.8%) patients. A total of 96 (92%) were positive for BCR ABL p190 rearrangement and 9 (8%) were positive for BCR ABL p210 rearrangement. Mean age of patients was 21 years. The frequency of BCR ABL gene was positive in 72% males and 28% females. BCR-ABL positive ALL was associated with higher TLC count. CNS involvement was more common in Acute Lymphoblastic Leukemia with BCR-ABL. The likelihood of post-induction remission decreased with age.</p> <p>Conclusion: In our study population, a frequency of 16.8% patients were BCR ABL1 positive in acute lymphoblastic leukemia. BCR- ABL gene mutation in ALL is more prevalent in young adults. The frequency of p190 rearrangement is more common than p210 BCR-ABL rearrangement. BCR-ABL positive ALL is more prevalent in males than in females.</p> Shabih Haider, Asad Mahmood, Fahim AKhtar, Rafia Mahmood, Saadia Muzafar, Maliha Batool Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Effectiveness of Laparoscopic Sleeve Gastrectomy for Weight Loss in Morbid Obese Patients <p><strong>Objective: </strong>To determine the effectiveness of laparoscopic sleeve gastrectomy for weight loss in morbidly obese patients at Capital Hospital, Islamabad.</p> <p><strong>Methodology: </strong>This descriptive case series study was done at Capital Hospital, CDA, Islamabad during a period of one-year from February 2019 to January 2020. All the patients with a body mass index of 35 or greater, with or without comorbidities, aged 18 to 65 years of either gender were included. All the patients underwent laparoscopic sleeve gastrectomy for weight loss. At the 1<sup>st</sup>, third, and 6<sup>th</sup> month’s follow-up, postoperative weight loss was noted. Effectiveness was taken in terms of &gt; 10% weight loss maintained at 6 months. </p> <p><strong>Results: </strong>The overall study participants' average age was 57±9.77 years, and females were in the majority (62%). Overall, laparoscopic sleeve gastrectomy was effective in 85% of patients and was not effective in 15% of patients. The average BMI was 37.31 kg/m<sup>2</sup>. Laparoscopic sleeve gastrectomy showed effectiveness in 57 (85%) patients, while 10 (15%) of the patients' weight was not lost. Effectiveness was statistically insignificant according to age, gender, and comorbidities, p-values were quite insignificant (&gt;0.05).</p> <p><strong>Conclusion: </strong>Laparoscopic sleeve gastrectomy was observed to be an effective technique for weight loss in morbid obese patients. It did decrease the morbidities and improve the quality of life.</p> Muhammad Naeem Taj, Israr Ahmed, Yasmin Iqbal, Zakia Akbar, Muhammad Aamir Saeed, Muhammad Adnan Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Diabetes and Inflammation; Association Between C-Reactive Protein and Diabetic Nephropathy in Rawalpindi <p><strong>Objective:</strong> To determine the frequency of elevated C-reactive protein in type 2 diabetics and to compare the levels of C-reactive protein between people with diabetes and non-diabetics nephropathy among the population of Rawalpindi, Pakistan.</p> <p><strong>Methodology:</strong> This cross-sectional study Diabetic and Medical OPD of Fauji Foundation Hospital, Rawalpindi from January 2019 to July 2019. A total of 150 patients who had type 2 diabetes, aged between 35 to 60 years, irrespective of gender, were included. Blood samples were collected for blood sugar random, fasting, renal function test, WBC count, and C-reactive protein. Urine samples were collected for the measurement of 24-hour urinary proteins. The presence or absence of proteinuria was used to categorize patients into two groups. Group A consisted of 58 patients with type 2 diabetes who did not have nephropathy, and Group B consisted of 92 patients with type 2 diabetes who had nephropathy (proteinuria greater than 30 mg/dl in 24 hours).</p> <p><strong>Results:</strong> The mean age in our study was 49.41+7.66. Ninety-two patients (61.3%) presented with diabetic nephropathy. CRP levels (&gt; 8200 ng/ml) were raised in 50 (54.3%) patients of group B and 19 (32.8%) patients of group A. The difference was statistically significant (p-value 0.010).</p> <p><strong>Conclusion:</strong> This study showed a higher prevalence of raised CRP in type 2 diabetics with nephropathy. This reinforces the idea that low-grade inflammation has an essential role in the inception and evolution of diabetic renal disease.</p> Hassan Salim, Shahida Perveen, Mahwish Niaz, Omar Ahsan, Umm-e- Farwa, Rehana Ramzan Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Outcome of Kangaroo Mother Care in Preterm, Low Birth Weight Neonates; A Randomized Control Trial <p>In a recent meta-analysis, based on 13 randomized control trials, the researchers concluded that the neonates care with KMC at least 6 hours per day got significant weight gain as compared to the Non-KMC group with a mean difference 8.99 gm per day. They also concluded that the infants received KMC for less or equal to 02 hours per day not showed a significant difference in weight gain as compared to controls.<sup>16</sup></p> Nadeem Ahmad, Syeda Shireen Gul, Muhammad Hayat Khan, Fasih Hashmi, Azka Batool, Ambreen Fatima Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Outcome of Non-Invasive Ventilation in Severe Corona Virus Disease of 2019 Patients; A Prospective Cohort Study <p><strong>Objective:</strong> To determine the Outcome of non-invasive ventilation in patients with severe COVID-19 pneumonia.</p> <p><strong>Methodology:</strong> A prospective cohort study was conducted at Pak Emirates Military Hospital, Rawalpindi, from 4th June to 30th Dec 2021. This study included 87 patients between the ages of 45 and 75 who were admitted due to severe acute respiratory syndrome coronavirus 2 (SARSCoV2) infection.Infection was confirmed by SARS-COV-2 PCR (polymerase Chain reaction). These patients were symptomatic with radiological evidence consistent with COVID-19 pneumonia requiring non-invasive ventilation (NIV) trial. The primary outcome was to analyze the success and failure of using NIV, the need for invasive ventilation, as well as the mortality rate. SPSS 21 was used to enter and analyze the data.</p> <p><strong>Results:</strong> The mean age was 62.89 ±7.55 years. There were 65(74.7%) males and 22(25.3%) females. NIV was successful in 33 (37.9%) patients, while 54 (62.1%) patients required endotracheal intubation (invasive ventilation). Out of these 54 patients, 44 (81.4%) died after intubation. The mean duration of NIV support was observed as 6.2 ± 3.9 days.</p> <p><strong>Conclusion:</strong> NIV can prevent intubation in less than half of the patients, according to our findings.</p> Roshaan Tahir, Adnan Manzar, Ammarah Mehmood, Umer Mehmood, Aitzaz Khan Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Peer Assisted Learning; The Perspective of Peer Tutors <p><strong>Objective:</strong> To determine the perspective of PAL tutors regarding the effectiveness of PAL in promoting knowledge and skills among the undergraduate students using small group discussions in an integrated module.</p> <p><strong>Methodology:</strong> A prospective qualitative method study was conducted at Rawal Dental College, Islamabad, from April to June, 2021, for 12 weeks. Students from the second year of BDS (n = 50) were divided into five small groups. Five students’ volunteers were chosen from those who completed the previous units with more than 80% summative assessment score and with good communication skills. The group discussion centered on the application of core knowledge and skills in pathology. Responses from the tutors for the qualitative data were obtained using in depth one-on-one semi-structured interviews with audio recorded. The verbatim in the form of audio and notes were transcribed, and the qualitative analysis was performed by two independent investigators, generating codes, themes, and subthemes.</p> <p><strong>Results: </strong>The results showed the comprehensive understanding of the insights of tutors and the motivational elements for achieving academic goals and improving teamwork and teaching skills. Many factors encouraged their participation as tutors, including the acquisition of knowledge and leadership skills. The students felt that their compassionate attitude encouraged active participation by the fellow students, increasing their confidence and learning. The students perceived that they had attained essential attributes that would benefit them in professional life in the future.</p> <p><strong>Conclusion: </strong>The students enjoyed the Peer-assisted learning experience and recognized its importance for their academic and professional development. While learning in a relaxed environment, the students achieved their basic learning goals, developed leadership skills, improved communication skills, and gained confidence.</p> <p><strong>Keywords: </strong>Peer Group, Integrated curriculum, Near-Peer tutoring.</p> <p> </p> Aisha Akbar, Muhammad Nasir Ayub, Maliha Atif, Huma Jawad, Hassan Mumtaz, Taqdees Iftikhar Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Foeto-Maternal Outcome in Women with Placenta Praevia and Morbidly Adherent Placenta Praevia <p><strong>Objective: </strong>To determine the maternal and foetal outcome in pregnant women with placenta praevia and morbidly adherent placenta praevia</p> <p><strong>Methodology</strong>: A prospective case series was carried out in a tertiary care institution between 2019 and 2021. All pregnant women with placenta praevia and placenta accreta spectrum who were over 28 weeks gestation were included, regardless of whether they received their diagnoses during pregnancy or during surgery. Data was collected on structured proforma regarding demographic characteristics, obstetric factors, management options, and intraoperative complications to determine foeto-maternal outcome in women with placenta praevia and morbidly adherent placenta praevia.</p> <p><strong>Results: </strong>Total number of patients with placenta praevia was 140; out of which 31 (22.1%) had placenta accreta spectrum. All cases of morbid adherence were found in major degree placenta praevia (p= 0.00). Antepartum haemorrhage in current pregnancy was more associated with placenta praevia as compared to morbidly adherent placenta praevia (p=0.00). Both placenta praevia with and without morbid adherence led to preterm birth (p=0.00). LSCS as mode of delivery in previous pregnancy, step-wise-devascularization, caesarean hysterectomies, bladder injury, blood loss more than 1000ml, number of blood transfusions, and mothers required ICU care were significantly associated (p≤0.05) with morbidly adherent placenta praevia as compare to placenta praevia without morbid adherence. In cases of placenta accreta spectrum; 11(33.3%) babies were admitted in NICU as compare to 29(25.9%) in placenta praevia without placenta accreta spectrum.</p> <p><strong>Conclusion: </strong>Placenta praevia is adversely affected by placenta accreta spectrum is associated with higher foeto-maternal morbidity as compared to placenta praevia without adherence.</p> Rashida Sultana Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Comparison of the Mesio-Distal Widths of the Maxillary and Mandibular Central Incisors Between Cleft Lip and Palate and Non Cleft Lip and Palate Individuals <p><strong>Objective:</strong> To compare the mesiodistal widths of the maxillary and mandibular central incisors of cleft lip and palate individuals with non-cleft individuals, in a local population.</p> <p><strong>Methodology:</strong> A total of 80 casts (40 of cleft patients and 40 normal) were selected by the department of orthodontics from January, 2021 to February, 2022, dividing them it into 4 groups by consecutive non-probability technique. The mesiodistal width of the maxillary and mandibular central incisors was measured with vernier caliper. Independent t test was applied to compare the mesiodistal width of maxillary and mandibular central incisors between normal and cleft patients. Descriptive statistics were calculated for all four groups.</p> <p><strong>Results:</strong> The mean MD width for the maxillary central incisors was 6.58 ± 1.16mm and 7.67 ±1.18mm for the CLP and control group respectively. The mean MD width for the mandibular central incisors was 4.22± 0.91 mm and 4.67 ± 0.9 mm for the CLP and control group respectively. The student t test showed a significant difference in the MD width of both the maxillary and mandibular central incisors between the CLP and control group.</p> <p><strong>Conclusion:</strong> Patients suffering from cleft lip and palate are associated with diminutive central incisors in both jaws.</p> Ali Ayub , Umar Hussain , Falahat Nasir, Ausaf Ali Rizvi Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Assessment of the Predictors and Mortality in Patients of Acute on Chronic Liver Failure; A Prospective Study <p><strong>Objective:</strong> To evaluate the predictors of short-term mortality in patients with acute-on-chronic liver failure (ACLF).</p> <p><strong>Methodology:</strong> This prospective study was conducted at the gastroenterology department of the Asian Institute of Medical Sciences Sindh, Pakistan from January 2018 to December 2018. All the patients with acute-on-chronic liver failure (ACLF) aged more than 25 years and of either gender were included. A complete history was obtained including demographic profile and specifics on clinical characteristics (jaundice, ascites, gastro-intestinal bleed, grade of encephalopathy, records of vital parameters etc.). Serum electrolytes, viral serology, autoimmune profile, liver function tests, serum creatinine, prothrombin time, and INR were among the laboratory tests performed on each patient.</p> <p><strong>Results:</strong> A total of 99 patients were studied; their average age was 40.90+13.93 years; and there was a male predominance (73.5%). HCV and HBV+HDV were the most common etiological factors. According to the frequency of organ failure, hepatic failure was in 59.8% of the cases, renal failure was in 43.6% of the cases, CNS failure was in 38.5% of the cases, 41.0% of the cases had circulatory failure, coagulation failure was in 55.6% of the cases, and respiratory failure was seen in 17.1% of the cases. Overall, the 30-day mortality rate was 61.5%. Hepatic failure, renal failure, CNS failure, coagulation failure, SBP, and grading of ACLF were significantly associated with short-term survival rate (p= &lt;0.05). While gender, etiology, circulatory failure and respiratory failure were statistically insignificant (p= &gt;0.05). MELD score &gt;28, CTP score &gt;13, organ failure &gt;3 and ACLF grade II and III were also highly significantly linked to short term survival rate (p-0.0001).</p> <p><strong>Conclusion:</strong> According to the study's findings, hepatic failure, renal failure, CNS failure, coagulation failure, and ACLF grading, CTP score &gt; 13, MELD score &gt; 28, and the presence of hepato-renal syndrome were found to be significant predictors of short-term mortality in patients with Acute On-Chronic Liver Failure (ACLF).</p> Rehmatullah Bhatti, Ubedullah Bughio, Adil Hassan, Abdul Hafeez Soomro, Jawaid Iqbal, Mashooque Ali Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Assessment of Clinicopathological Status and Outcome of Children with Tuberculous Meningitis at a Tertiary Care Hospital <p><strong>Objective: </strong>The aim of this study is to report the clinic-pathological profile of children with TBM and their treatment outcome.</p> <p><strong>Methodology:</strong> A retrospective observational study was conducted in the Pediatrics Department over 6 months period. Medical records of children admitted with TBM from November 2017 to May 2018 were reviewed for data collection. Data regarding clinical presentation, laboratory investigations were recorded. Patients were treated with a standard ATT regimen, and their outcome was noted. The study was approved by hospital ethics committee. Data was entered in SPSS for statistical analysis.</p> <p><strong>Results:</strong> Females were predominant 39 (55.7%) and age ranged from 4 months to 13 years in this study. Only 28 (42.0%) children were fully vaccinated and had BCG scar presence. Most TBM cases were of stage II 24 (42.8%) or stage III 29 (42.8%). The frequent symptoms were fever 61 (87.1%), rigidity/irritability 35 (50.0%), and seizures 26 (37.1%). WBCs count in CSF was found below 500 in 64 (91.4%) children. There were 55 (78.5%) children with lymphocytosis and 14 (20.0%) with polymorph nuclear cells. A CT scan was suggestive of TBM in 51 (72.8%) children. Only 21 (30.0%) cases had a complete recovery whereas 17 (24.2%) recovered with sequelae and 10 (14.2%) deaths were noted.</p> <p><strong>Conclusion:</strong> TBM presents with a poor clinical and pathological state in the advanced stage of the disease, and the therapy outcome is also non-satisfactory with high mortality and sequelae posing constant challenges.</p> Maqbool Hussain, Sonaina Maqbool, Maryam Masood, Mishal Maqbool, Abrar Ul Haq Satti, Raza Hussain Shah et al Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Our Nuts and Bolts in The Permanent Pacemakers’ Explanation Techniques <p><strong>Objective:</strong> Our goal is to share our two decades of experience with implantable electrical device explanation at our electrophysiology centre at Hayat Abad Medical Complex in Peshawar.</p> <p><strong>Methodology:</strong> After baseline patient were brought nil by mouth to catheterization laboratory (Cath: lab). A temporary pacemaker (TPM) implanted for backup. In case of box change, a new device is attached after checking the integrity of the lead and device placed in the same pocket. But if of lead extraction was also needed, then stylet was put inside the lead and with twisting movement and mild traction the lead removed and new lead implanted with Seldinger<sup>,</sup>s technique, battery attached and wound closed in layers.</p> <p><strong>Results:</strong> Out of 1670, there were 1535 (91.9%) new implantations and 135 (8.08%) repeat procedures. The pulse generator was replaced without lead replacement in 59 (3.5%) patients. In 36 (2.15%) patients, the ventricular lead or atrial lead was successfully reposition. A total of 32 (1.9%) successful explanations were performed in the study period.</p> <p><strong>Conclusion:</strong> The explanation of devices like implantation needs special gadgets and training for the safe and successful procedure.</p> Shahab Saidullah, Bakhtawar Shah, Salman Habib, Asma Rauf Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Diagnostic Accuracy of Positron Emission Tomography-Computed Tomography (PET-CT Scan) In Detecting Bone Marrow Involvement in Patients with Diffuse Large B cell Lymphoma <p><strong>Objective:</strong> To evaluate the diagnostic accuracy of positron emission tomography combined with CT scan (PET-CT Scan) in detecting bone marrow involvement in patients with diffuse large B-cell lymphoma, keeping bone marrow biopsy as gold standard.</p> <p><strong>Methodology:</strong> From November 2017 to May 2018, a cross sectional validation study was carried out at the Aga Khan University in Karachi Department of Oncology's Section of Clinical Hematology. The study comprised a total of 112 patients who were identified as having diffuse large B cell lymphoma after a lymph node was implicated was histopathologically examined. All patients had a PET-CT scan and bone marrow biopsy technique as part of the staging workup. With bone marrow biopsy acting as the gold standard, the diagnostic efficacy of a PET-CT scan for identifying bone marrow involvement was evaluated.</p> <p><strong>Results:</strong> Of 112 patients, there were 71(63.39%) males and 41(36.61%) females. The mean age was 45.09±17.36 years. The mean duration of diagnosis was 17.19±6.02 days. Through biopsy, bone marrow involvement was identified in 40 (35.7%) cases. Through a PET-CT scan, bone marrow involvement was identified in 47 (41.9%) cases. The PET- CT scan in comparison with bone marrow biopsy for detecting bone marrow involvement in patients with DLBCL had a sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 95%, 87.7%, 80.85%, 96.92% and 90.18% respectively.</p> <p><strong>Conclusion:</strong> PET-CT scan can accurately detect bone marrow involvement in patients with DLBCL so it can be used in most patients instead of invasive bone marrow biopsy procedure for staging of DLBCL patients.</p> Mohammad Usman Shaikh, Danish Shakeel, Muhammad Hassan, Nayab Afzal, Natasha Ali, Salman Adil Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Relationship of Nucleated Red Blood Cells with Severity of Perinatal Asphyxia and its Short-Term Outcome <p><strong>Objective:</strong> To compare the nucleated red blood cell (NRBC) counts of healthy and asphyxiated newborns as a key clinical indicator of the severity of birth asphyxia and short-term outcome.</p> <p><strong>Methodology: </strong>This case control study was conducted at the paediatric department of neonatology of Recep Tiyyap Erdogan Hospital Muzaffargarh from June 2020 to November 2020. Study A total of 112 term newborns, including 56 cases (with birth asphyxia) and 56 controls (normal babies) aged &lt;24 hours, were included. After obtaining informed consent, blood samples were taken immediately after birth for the measurement of the NRBC count. All the enrolled cases were admitted to the NICU as per indication and observed for the severity of birth asphyxia. The relationship between the cord blood NRBC count and the severity of birth asphyxia was assessed. All the information was recorded using a self-structured study proforma, and SPSS version 26 was used for the purpose of data analysis.</p> <p><strong>Results:</strong> The overall average age of the neonates was 6.18+2.66 hours. Mean age, birth weight, and gestational age were statistically insignificant in accordance to cases and controls. Males were in the majority (75.0%), and females were 25.0% of the case group. The mean NRBCs in the cases were 16.62 + 17.10, which was significantly higher than the controls at 1.69 + 2.42 (p- 0.0001). The neonatal NRBs average was statistically insignificant according to gender in both cases and controls, while it was significantly associated with the severity of perinatal hypoxia (p 0.0001). The average NRBC count was also significantly higher in cases of cardiomegaly, those having ventilation needs and respiratory distress.</p> <p><strong>Conclusion:</strong> The mean NRBC was observed to be significantly higher in cases compared to controls. The NRBC was considered to be a non-invasive, simple prognostic marker for neonatal asphyxia, may indicate substantial severity of perinatal hypoxia and its related complications.</p> Mehwish Iqbal, Athar Razzaq, Fiaz Ahmad Malik, Muhammad Ali, Muhammad Imran, Maham Shahzadi Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Association of Anterior Alveolar Dimensions with Different Sagittal Jaw Relationships <p>and sagittal jaw relationship.</p> <p><strong>Methodology:</strong> This Cross-sectional study took place in Orthodontic Department, Institute of Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro, from August 2018 to January 2019.</p> <p>Patients of both genders ranging in age from 18 to 30 years were included. All the subjects, as per ANB angle, were grouped into three categories as (Class I = value between 1° and 4° for ANB angle), (Class II = value &gt; 5° for ANB angle) and (Class III= value &lt;1° for ANB angle). All the data was recorded in the Performa for the purpose of analysis.</p> <p><strong>Results:</strong> A total of 90 patients were studied; their average age was 21.12+3.47 years and 52.2% were females. Mean upper posterior alveolus width was significantly higher in sagittal class II as 12.69 ± 5.52 than in sagittal class I and III p-value 0.058. The mean upper anterior alveolus height was found to be significantly greater in class I and III in contrast to class II p-value 0.028. Mean lower anterior alveolus width was insignificantly related with sagittal classification, p-value 0.343. Mean upper anterior alveolus width and lower posterior alveolus width were insignificantly related to sagittal classification, and the p-value were quite insignificant. Sagittal class II and III were significantly associated with female gender 0.021, while class I was linked to male gender p-value 0.021.</p> <p><strong>Conclusion:</strong> There was a significant association between dimensions of anterior alveolar among different vertical and sagittal jaw association.</p> Abdul Jabbar, Muhammad Nazir, Maryam Mushtaq, Romesa Khero, Permanand, Muzaffar Qayum Khan Ghouri Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Comparison of Early Outcome of the Close and Open Technique for the Treatment of Distal Femur Fractures <p><strong>Objective:</strong> To compare the effects of closed and open techniques with its associated complications used for the management of distal femoral fracture in younger to older populations.</p> <p><strong>Methodology: </strong>This was a case series study conducted in the Department of Orthopaedic Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from Sept 2018- March 2019. A total of 66 adult patients were stratified according to treatment technique; closed technique group and open technique group with 33 patients in each group between age 18 - 65 years with fractured close distal 1/3rd shaft of femur distal femur fractures based on AO/OTA classification were included in the study. The Chi-square test was applied to contrast outcomes of closed and open technique and HSS score categories in both procedures.</p> <p><strong>Results: </strong>The study findings showed that the mean age of the patient was slightly greater in the open technique group (41.5 + 23.5 years) compared to the closed technique (29.8 + 11.8 years). Most of the patients had type A femur fracture. The postoperative mean HSS knee score was 70.1 + 15.1 in the open technique group compared to 74.5 + 12.5 in the closed technique group with an insignificant difference between the two means (p&lt;0.949). An insignificant difference was observed in postoperative infection, non-union, and implant failure between both groups.</p> <p><strong>Conclusion: </strong>This study concluded that superior outcomes such as bony union without infection were achieved in patients with femur fractures treated with closed technique as compared to open technique, although the findings were statistically insignificant. Moreover, the functional outcome of the knee joint was also distinctly improved in the closed technique.</p> <p><strong>Keywords: </strong> Distal femur fracture, retrograde intramedullary femoral nail, locking compression plate, complications</p> Ali Shami Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Comparison of MRI versus Arthroscopy in Assessment of Anterior Cruciate Ligament Injuries of The Knee Keeping Arthroscopy as Gold Standard <p><strong>Aims &amp; Objectives: </strong>To co-relate Magnetic Resonance Imaging findings with Arthroscopy through Sensitivity and Specificity, keeping Arthroscopy as a gold standard.</p> <p><strong>Design:</strong> Prospective cross-sectional study</p> <p><strong>Materials and Methods: </strong>The study was conducted from February to August 2019 in the Department of Orthopedic Surgery, Combined Military Hospital, Rawalpindi, after receiving approval from the Ethical Committee. MRI of 127 patients was done who had clinical signs of ACL injury and then were booked for Arthroscopy.</p> <p><strong>Results: </strong>There was a male preponderance, with 85.8 % being male. The majority of the patients were of 2<sup>nd</sup> and 3<sup>rd</sup> decade of life. The specificity, sensitivity, NPV, PPV, and Accuracy of MRI in assessing anterior cruciate ligament injuries were calculated in percentages of 64.28%, 89.89 %, 64.28%, 89.89%, and 84.25%, respectively.</p> <p><strong>Conclusion: </strong>MRI is accurate and a non-invasive modality for assessing anterior cruciate ligament tears with good accuracy and better sensitivity. However, diagnostic Arthroscopy remains the gold standard for diagnosing anterior cruciate ligament injuries.</p> Auon Shabbir Khan Niazi, Muhammad Uzair Khan Niazi, Irta Zainab, Hassan Mumtaz, Midhat Zahra, Adnan Anwer Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 P53 Over Expression in Bladder Carcinoma <p> </p> <p>Objective: The goal of this study was to find out how common p53 overexpression is in bladder urothelial carcinoma.</p> <p><strong>Material &amp; Methods: </strong>This Descriptive, Cross-Sectional Study has been done during April 10th to October 9th, 2018 at the KRL Hospital Islamabad. A total of 74 patients with biopsy-proven urinary bladder carcinoma, ranging in age from 15 to 70 years old and regardless of gender, were included in the study. Patients undergoing radiotherapy, immunotherapy, or who had previously received an immunohistochemistry report were excluded. Following that, the immunohistochemical processing was completed, and the results for p53 expression (positive/negative) were interpreted by the consultant pathologist.</p> <p><strong>Results: </strong>The participants in this study ranged in age from 15 to 70 years old, with a mean age of 47.39 10.26 years. The male to female ratio was 1.6:1 among these 74 patients, with 45 (60.81 percent) being male and 29 (39.19 percent) being female. Overexpression of p53 was found in 31 (41.89 percent) of bladder urothelial carcinoma cases.</p> <p><strong>Conclusion: </strong>This study concluded that the frequency of p53 overexpression in bladder urothelial carcinoma is very high<strong>.</strong></p> Sabeen Afshan, Laila Zaib, Sumera Sharif, Javeria Faridi, Farzana Habib, Aisha Akbar Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 The Variation of Normal Portal Venous Doppler Indices in Post-Operative Period following Living Donor Liver Transplant. <p><strong>Background:</strong></p> <p>Liver transplant is the treatment of choice for irreversible acute liver failure and end-stage chronic liver disease. Patient prognosis in the early pot-operative phase is most adversely impacted by vascular complications. The most appropriate tool for assessing vascular patency is ultrasound. Hence, it is of utmost importance that radiologists are able to recognize acceptable variations in normal Doppler indices to prevent false alarms. This article describes normal variations in post-operative doppler assessment of the portal vein.</p> <p><strong>Materials and Methods:</strong></p> <p>This retrospective cohort study was carried out at Pakistan Kidney and Liver Institute and Research Centre from July 1 to December 31 2021. It included all adult patients over 16 years of age who underwent Living Donor Liver Transplant (LDLT). Triplex Doppler ultrasound of LDLT recipients was performed intraoperatively and postoperatively for 5 consecutive days. Subsequent scans were performed at 2 weeks, 4 months, and 6 months after the transplant. Portal vein velocities were taken at the extrahepatic part, anastomosis, and intrahepatic part. Statistical analysis was performed using SPSS version 20.</p> <p><strong>Results:</strong></p> <p>We had 91 patients. The minimum age was 17 years, the maximum age was 73 years, and the mean age was 44.9 years. 79% of the recipients were males and 21% were females. The portal venous velocities ranged from 31 cm/s to 357 cm/s. All patients had antegrade portal venous flow. The portal venous velocities normalized in 4-6 months following LDLT.</p> <p><strong>Conclusion:</strong></p> <p>A wide range of portal venous velocities can be encountered following LDLT without clinically significant outcome and these usually normalize within 4-6 months following LDLT.</p> <p>&nbsp;</p> Muhammad Salman Rafique Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300 Burns; A Scar Means I Survived! Muhammad Rehan, Tariq Iqbal, Momina Baig Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Sun, 11 Sep 2022 00:00:00 +0300